1. Mental Health, Addictions Counseling and Medical Services Linkages May 29, 2013 For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

2. 2  Welcome & Overview, 5 mins  Integrating Mental Health, Substance Use and Medical Programs 30mins  Panel Discussion on Behavioral Health and Medical Service Integration, 20 mins  Wrap-up & Evaluation, 5 mins Michael Hager in+care Campaign Manager National Quality Center New York, NY michael@nationalqualitycenter.org Conversation opportunities throughout webinar Agenda

3. 3 For more information: www.incarecampaign.org  This Partners in+care webinar is offered as part of the in+care Campaign.  The in+care Campaign is a national effort to improve retention in HIV care.  Webinars are one of many Partners in+care activities designed to engage people living with HIV/AIDS and their allies in the in+care Campaign. Welcome & Overview

4. 4  This is a “public event.” If you have confidentiality concerns:  Your names appear on-line in the list of webinar registrants -consider just listening to the audio or to viewing the webinar at a later time, after it is posted at www.incarecampaign.org  All webinars are recorded - do not use identifying information when asking questions Participation Guidelines For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

5. 5  Actively participate and write your questions into the chat area during the presentation; we will also have a “pop up” question exercise, and will pause for conversation during the webinar  Do not put us on hold  Mute your line if you are not speaking (press *6, to unmute your line press #6)  The slides and recording of this and other Partners in+care webinars are available for playback and group presentations at www.incarecampaign.org – “Resources” tabwww.incarecampaign.org For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368# Participation Guidelines

6. 6 Visit www.incarecampaign.org Pop-up Question Yes, we are a one-stop shop. Everything onsite! Yes, we have a formal linkage arrangement with outside providers that is not grant supported Yes, we have a formal linkage arrangement with outside providers that is grant supported I have no idea… I do not work for an HIV service organization Service Integration and Linkages Does your organization offer its patients access to behavioral health or medical services? Adam Thompson Peer Consultant National Quality Center Fredricksburg, VA adamtthompson@gmail.com

7. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. WWW.SAMHSA.GOV Humberto M. Carvalho, MPH Project Officer Health Systems Branch/Division of Services Improvement Center for Substance Abuse Treatment E-mail: humberto.carvalho@samhsa.hhs.govhumberto.carvalho@samhsa.hhs.gov David C. Thompson Team Leader-HIV/AIDS Programs Health Systems Branch/Division of Services Improvement Center for Substance Abuse Treatment E-mail: david.thompson@samhsa.hhs.govdavid.thompson@samhsa.hhs.gov

8. 8 Integrating substance abuse, mental health and HIV services Currently funding grants to support substance abuse and mental health services integrated with HIV prevention and treatment services Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High-Risk for HIV/AIDS – 2012 grant -52 grantees awarded Targeted Capacity Expansion: Substance Abuse Treatment for Racial/Ethnic Minority Women at High Risk for HIV/AIDS - 2013 grant

9. 9 New Orleans AIDS Task Force Juliet Catrett, LCSW-BACS Behavioral Health Supervisor Email: julietc@noaidstf.orgjulietc@noaidstf.org Lisa Breland Director of Client Services Email: lisab@noaidstf.orglisab@noaidstf.org

10. Recovery Works Program NO/AIDS TASK FORCE

11. 11 Client Demographics: Gender: Male: 75.5% Female: 20.2% Transgender: 3.8% Race: Most clients identify as Black/African American (52.4%) or White (33.2%) Hispanic/Latino: 5.8% Mean age was 41.2 years of age with most clients having a high school/GED or lower (62.5%) education level

12. 12 Clients’ Housing and Income Mean monthly income: $657.24 Most clients are unemployed (38%) or disabled or retired (36.5%) Most clients live in own apartment (54.8%) or someone else’s apartment/house (23.1%)

13. 13 Significant Changes from Intake to 6 Month Follow Up ASI Composite Drug Use Score ASI Composite Alcohol Use Score Days of illegal drug use Days of illegal drug use index Days of drug use, substance of choice Days of alcohol use to intoxication Days experiencing alcohol problems Amount of money spent on alcohol Drug severity Index Rating (from the SIR) Alcohol Severity Index Rating (from the SIR) Males’ mean number of male partners Percentage of clients using drugs or alcohol before or during sex

14. 14 Substance Use: Intake to Six Month Follow Up

15. 15 High Risk Sexual Behaviors: Intake to 6 Month Follow Up, Males

16. 16 Outreach Our Outreach team is responsible for distributing program pamphlets to other ASOs and residential programs, recruiting clients, and completing follow up GPRAS. Our completion rate for follow up GPRAS was 89.2%

17. 17 Agencies Contacted through Outreach Program

18. 18 Informational Materials Distributed to Agencies

19. 19 Number of Potential Clients Referred to Program

20. 20 Clients Enrolled in Recovery Works

21. AIDS ALABAMA Dr. Joseph E. Schumacher Evaluator for the AIDS Alabama LIBCAP Program. Professor of Medicine, Clinical Psychologist, and Behavioral Scientist in the Division of Preventive Medicine at The University of Alabama at Birmingham. Email: jschumacher@uabmc.edujschumacher@uabmc.edu Mitchell Traver Living In Balance Chemical Addiction Program Coordinator AIDS Alabama Email: mitchell.tarver@aidsalabama.org mitchell.tarver@aidsalabama.org

22. LIBCAP Living in Balance Chemical Addiction Program Elaine Cottle Mitchell Tarver Dr. Joseph E. Schumacher The LIBCAP Team from AIDS Alabama This project was sponsored by a grant to ADIS Alabama from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services (DHHS).

23. 23 AIDS Alabama Incorporated as a nonprofit in 1986 with the mission of serving persons with HIV. AIDS Alabama is the largest HIV/AIDS service provider in the state HIV testing, prevention, and housing (170,000 nights of housing to 750 HIV-positive individuals and their families) Only agency in the state with substance abuse and mental health programs for PLWHA.

24. 24 LIBCAP: The Story Elaine and Dr. Schumacher meet Evidence-based treatment Needs assessment and training plan SAMHSA HIV capacity expansion grant in 2009 Last year of LIBCAP grant Sustainability

25. 25 LIBCAP Substance abuse treatment, housing, vocational development, case management, and aftercare program. Problems related to drug and alcohol addiction and homelessness among persons living with HIV and AIDS. Four housing-based treatment phases: The Rectory, Next Step, and Re-Entry. Living in Balance: Moving from a Life of Addiction to a Life of Recovery (Hoffman, Landry, and Caudill, 2003)

26. 26 Living in Balance Listed in NREPP and published by the Hazelden Foundation 33 scripted sessions of didactic, experiential, and psycho-education strategies focusing on drug education, relapse prevention, and HIV/STD prevention Each session contains similar elements including visualization/relaxation exercises, group exercises, written/oral exercises, role-play activities, and homework assignments.

27. 27 Program Evaluation Intake rate: 307/405 = 75.8% Follow-up rate: 219/274 = 79.9% GPRA outcomes Site specific assessments DSM IV SUD Checklist Patient Health Questionnaire (PHQ) Treatment Readiness Ruler (TRR) HIV Risk Assessment for Positives (HRAP) Tobacco Use Questionnaire (TUQ)

28. 28 GPRA Outcomes GPRA Measure% at intake% at 6-mosRate of Change Did not use drugs or alcohol22.8%68.5%+200% No past 30 day arrests93.2%95.0%+2% Currently employed6.4%26.5%+314% No health/social conseq’s18.3%72.9%+298% Were socially connected89.5%95.9%+7% Had permanent housing11.9%14.6%+23%

29. 29 Total sample (N=123) Discharged (N=83) Completed (N=40) Test statisticp value Sex (#, %) Male Female 86 (69.1%) 27 (30.9%) 55 (66.3%) 28 (33.7%) 31 (77.5%) 9 (22.5%) χ 2 =1.671 p=0.196 Race (#, %) Caucasian African American 22 (17.8%) 99 (80.5%) 14 (17.1%) 67 (81.7%) 8 (20.0%) 32 (80.0%) χ 2 =.903 p=0.628 Age M (SD) 43.3 (8.3)42.5 (8.8)44.4 (6.9)t=-1.51p=0.253 Table 1. Demographic characteristics by treatment completion status

30. 30 Table 2. Substance use disorders by treatment completion status

31. 31 Total sample (N=123) Discharged (N=83) Completed (N=40) Test statisticp value Treatment readiness: M (SD) 8.0 (1.9) 7.9 (2.1) 8.3 (1.6) t=-1.35 p=0.181 PHQ-9 depression: M (SD) 8.5 (7.1) 8.3 (6.9) 8.8 (7.8) t= -.355 p=0.723 PHQ-5 anxiety: M (SD) 1.2 (2.0) 1.3 (2.1) 1.0 (1.9) t=0.595 p=0.553 HIV risk behaviors: M (SD) 1.3 (1.8) 1.29 (1.3) 1.38 (2.5) t=-.215 p=0.831 Suicidal thoughts (#, % yes) 30 (24.4%) 19 (22.9%) 11 (27.5%) χ 2 =4.76 p=0.19 Table 3. Psychosocial characteristics by treatment completion status

32. 32 Lessons Learned HIV Specific Treatment: Blessing and a Curse Men + Women +LBGT = Drama Vocational goals were difficult to meet Retention and Completion Challenge Good chances of sustainability

33. Panel Discussion

34. 34 Integrating Behavioral Health and Medical Services Panel Discussion David Thompson SAMHSA david.thompson@samhsa.hhs.gov Adam Thompson NQC adamtthompson@gmail.com Joseph Schumaker, MD AIDS Alabama jschumacher@uabmc.edu Juliet Catrett, LCSW-BACS NO AIDS Task Force julietc@noaidstf.org Lisa Breland NO AIDS Task Force lisab@noaidstf.org

35. 35 Campaign Headquarters: National Quality Center (NQC) 90 Church Street, 13 th floor New York, NY 10007 Phone 212-417-4730 Visit Web / Open the Toolkit www.incarecampaign.org - “Partners” tab www.incarecampaign.org Sign up for Partners in+care Network www.incarecampaign.org – “Partners” tab www.incarecampaign.org Join Facebook Send email to incare@NationalQualityCenter.org – “Facebook” in subject line incare@NationalQualityCenter.org Partners in+care Resources